By Dr Poonam Khetrapal Singh, Regional Director WHO South-East Asia
DILI, 24 november 2022 (TATOLI) – Health leaders have a unique opportunity to strengthen patient safety, capitalizing on the unprecedented momentum catalyzed by the COVID-19 response.
In the WHO South-East Asia Region and across the world, the COVID-19 pandemic has accelerated improvements in the quality of healthcare services, especially in patient safety and infection prevention and control (IPC). Intensified health worker training – both in-person and online – and additional resource allocations have not only helped protect health workers and prevent COVID-19 infection in healthcare facilities but also strengthened awareness of and adherence to patient safety and IPC guidelines and protocols, from the ‘5 moments for hand hygiene to the ‘Know. Check. Ask’ about the protocol for safe medication usage.
Such improvements are critically important, for patients and health workers – yes, but also to accelerate progress towards universal health coverage (UHC), which is not only about coverage and affordability, but also quality.
The numbers are staggering. Each year, between 5.7 and 8.4 million deaths in low- and middle-income countries (LMICs) globally, including in the Region, are attributable to substandard care, which accounts for up to 15% of all deaths in these countries. An estimated 60% of deaths in LMICs from conditions requiring health care are due to poor quality care. The remaining 40% result from the non-utilization of the health system.
Globally, health-care associated infections (HAIs) affect an estimated 15 out of every 100 patients in LMICs, killing around 1 in every 10 affected patients. HAIs are often caused by inadequate hand hygiene, which is in turn caused by insufficient awareness of and access to safe water, sanitation, and hygiene (WASH) in healthcare facilities.
At present, both the Region and the world are off-track to achieve the 2022 global target of ensuring that at least 60% of all healthcare facilities provide basic WASH services. However, six countries in the Region are now implementing the WHO/UNICEF WASH FIT tool, which all countries should urgently adopt.
Commendably, most countries of the Region now have in place national patient safety and/or quality strategies that are aligned with the Region’s Strategy for Patient Safety 2016–2025, as well as the new Global Patient Safety Action Plan 2021–2030. In all countries, policymakers and program managers continue to incorporate patient safety into disease-specific and clinical program areas, and several countries now have in place specific administrative structures tasked with ensuring healthcare quality and safety.
However, health leaders continue to face an array of challenges, not least lack of political support and funding, inadequate equipment and infrastructure, poor or non-existent monitoring and evaluation, and a disconnect between national-level programs and implementation at the community level, in primary healthcare facilities.
And it is in those facilities that action is especially needed – a point repeatedly highlighted at a WHO-convened Regional meeting in Bangkok, Thailand in October. For that, policymakers can intensify action in several key areas, accelerating Region-wide efforts to reorient health systems towards quality, resilient primary health care to achieve UHC, health security, and Health for All.
First, leveraging increased awareness of the importance of quality of care, patient safety, and IPC to ensure that key guidelines and protocols are adequately integrated into national, subnational, and facility-level planning. The political commitment must continue to be strengthened and should complement efforts to better protect health workers and improve occupational health and safety standards.
Second, enhancing ownership, engagement, and collaboration among the full range of primary care stakeholders. Private providers, professional bodies, academic institutions, patient advocacy, and other civil society and community groups must continue to be brought together, engaged, and empowered. Patients must be encouraged not only to be aware of their rights but also of how they can contribute to the quality of care, patient safety, and IPC, including by complying with facility protocols and directives.
Third, ensuring accountability and compliance. For this, data on the implementation of core components of quality of care, patient safety, and IPC should be standardized as per WHO guidelines and fed into centralized digital health information systems. It should then be rapidly analyzed to identify gaps and challenges and to guide additional investments for maximum impact.
Fourth, continuing to facilitate collective learning and innovation. Primary-level providers in particular face challenges that are often unique, and require innovative, out-of-the-box thinking to address. To enable those providers to share experiences, innovations, and ideas, digital technology is especially useful and must be harnessed and applied to maximum effect.
Patient safety is everyone’s business. On medication errors alone, the world loses an estimated US$ 42 billion annually, excluding lost wages, productivity, or health care costs. In LMICs, unsafe and poor-quality care leads to a US$ 1.4 trillion to US$ 1.6 trillion loss in productivity every year. Amid the intense fiscal pressures imposed by the COVID-19 crisis, as well as broader geopolitical events and challenges, investments in the Region to strengthen the quality of care, patient safety, and IPC will pay for themselves many times over.
Action cannot and must not wait. For a South-East Asia Region in which no one is harmed in health care, WHO will continue to provide Member States its full technical and operational support – because every patient deserves safe and respectful care, every time, everywhere.
TATOLI
